FAKTOR RISIKO OBESITAS PADA MURID SEKOLAH DASAR USIA 6 - 7 TAHUN DI SEMARANG

Abstract

Faizah Z, Mexitalia M, Susanto JC, Sidhartani M Department of Child Health, Medical Faculty Diponegoro University Dr. Kariadi General Hospital Semarang Indonesia BACKGROUND — Obesity is one of nutritional problems which often encountered, and potentially cause health disturbance due to several complications and high risk of co-morbidity. There are several factors that may contribute as etiology and risk factors of obesity. There are still a few studies on the risk of obesity of Elementary School students at 6 - 7 years, at the period of adiposity rebound when fat content is minimal and have not been influenced by endocrine system at the age of 6 years old, and fat accumulation will be rebound after wards with the possibility of adult obesity. AIM — The aim of this study is to investigate patients' characteristics and the risk factors of obesity on children at age of 6 - 7 years old (adiposity rebound period) in Semarang. MATERIAL AND METHOD — A cross sectional study was conducted in October 2003 -March 2004. The subjects were 1.157 elementary school students that had been chosen randomly from 15 state and private school in Semarang. The anthropometric parameters were measured. Risk factors and other related variables were collected from parents by self administered questionnaire. BMI was calculated as Weight/Height2(kg/m2) and classified as obesity based on NCHS curve > 95th percentile. Data were analyzed using Chi — square, t-test, one way Anova. Risk factors were determined by logistic regression analysis. RESULTS — Obesity was found on 123 subjects (10.6%) that composed of 83 male and 40 female students. Based on logistic regression analysis, the risk factors of obesity were male (OR=2.3; 95% CI =1.2 to 4.4), Chinese (OR=2.3; 95% CI =0.8 to 6.2), the increase of mother body weight during pregnancy > 10 kg (OR=1.5; 95% CI = 0.8 to 3.0), twin obesity (OR=2; 95% CI= 0.4 to 9.4), eating frequency > 3 X/day (OR=3.7; 95% CI =0.8 to 16.5), stay at more than 2-storied house i.e. associated to high social economic level (OR=2.3; 95% CI = 1.2 to 4.4). Several known obesity risk factors such as parental obesity, infant obesity, birth weight > 4000 grams, breast feeding duration < 6 months, low physical activity were inconclusively determinant as risk factors of obesity. CONCLUSIONS — Sex male, Chinese race, mother weight gain during pregnancy > 10 kg, twin obesity, eating frequency > 3 X/day, high social economic status were determined as risk factors of obesity on 6-7 years children. Bagian Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Diponegoro Rumah Sakit Dr. Kariadi Semarang Abstrak Latar Belakang Obesitas merupakan masalah gizi yang sering dijumpai, dan potensial untuk mengakibatkan gangguan kesehatan akibat berbagai komplikasi, dengan risiko komorbiditas yang tinggi. Terdapat berbagai macam faktor risiko dan etiologi yang multifaktorial untuk terjadinya obesitas. Belum banyak diteliti faktor-faktor risiko obesitas pada murid Sekolah Dasar usia 6 — 7 tahun, pada masa adiposity rebound di mana lemak tubuh paling sedikit dan belum dipengaruhi sistem endokrin pada usia 6 tahun, dan penimbunan sel lemak akan meningkat kembali (rebound) di mana usia mulai rebound ini sangat menentukan untuk terjadinya obesitas yang menetap. Tujuan Mengetahui faktor risiko obesitas pada murid Sekolah Dasar usia 6 — 7 tahun (masa adiposity rebound) di Semarang dan karakteristik pasien obesitas serta hubungan antara faktor risiko dengan anak obes dan non-obes. Metodologi Disain penelitian adalah belah lintang dengan subyek semua anak usia 6-7 tahun sebanyak 1157 yang bersekolah di 15 SD Negeri dan Swasta di Semarang yang dipilih secara acak (duster random) pada bulan Oktober 2003 — Maret 2004. Dilakukan pemeriksaan antropometri dan dibagikan kuesioner mengenai faktor risiko obesitas yang diisi oleh orang tua. Indeks Masa Tubuh (IMT) ditetapkan berdasarkan pengukuran BI3fTB2 (kg/m2) dan digolongkan sebagai obesitas berdasarkan kurva NCHS persentil ke-95. Analisis data menggunakan analisa bivariat dengan Kai kuadrat, t-test, one way Anova, serta analisa muitivariat menggunakan regresi logistik. Hasil Obesitas didapatkan pada 123 subyek (10,6%) yang terdiri dari 83 laki-laki dan 40 perempuan. Berdasarkan analisis regresi logistik, faktor-faktor risiko obesitas meliputi jenis kelamin laki-laki (OR=2.3; 95% CI = 1.2 - 4.4), WNI keturunan (ras Cina) (OR=2.3; 95% CI = 0.8 - 6.2), peningkatan berat badan ibu saat hamil > 10 Kg (OR=1.5; 95% CI = 0.8 - 3.0), kembar obes (OR=2; 95% CI = 0.4 - 9.4), frekuensi makan > 3 x/hari (OR=3.7; 95% CI = 0.8 - 16.5), rumah bertingkat yang menunjukkan status sosial ekonomi tinggi (OR=2.3; 95% CI = 1.2 - 4.4). Beberapa faktor risiko obesitas seperti orang tua obes, anak gemuk pada tahun pertama, berat lahir > 4000 gram, pemberian ASI < 6 bulan, dan aktivitas fisik yang rendah merupakan determinan faktor risiko yang inkonklusif. Kesimpulan Faktor risiko obesitas anak usia 6 — 7 tahun adalah jenis kelamin laki-laki, ras Cina, kenaikan berat badan ibu sewaktu hamil > 10 Kg, kembar obes, frekuensi makan > 3 x/hari, dan status sosial ekonomi tinggi.